Theme: Simulated patients/simulation 

Transition to Parenting Course (T2P): The use of case-based reflection to assess skills in supporting parents through the transition to parenthood.

Dr Caroline Fertleman, The Whittington Hospital, *Jordan CE, Bourne T, Clark M, Fertleman CR

Introduction

T2P is a simulated learning experience, which develops knowledge and skills to support parents through their transition to parenthood.1 It was piloted in 2015 by a multidisciplinary faculty; aimed to facilitate inter-professional learning amongst candidates.

Reflection is essential for effective learning, to develop insight into our practice. ‘It is not sufficient simply to have an experience in order to learn. Without reflecting upon this experience it may quickly be forgotten, or its learning potential lost. (Gibbs 1988)2

Methods

Candidates are required to complete pre-course reading, followed by group discussion. Each candidate then participates in one of a variety of simulated role-plays, using actors. The scenarios are designed to challenge the candidate's communication skills, in a realistic setting. They include: adjustment to role of parent, relationship issues, support, anger, financial and housing difficulties.

Assessment is continuous throughout the day, including a personal feedback session. Each candidate must then submit a reflective piece, in order to complete the course. This should be a reflection on a new case, utilising the skills learned during the course.

Results

Reflective pieces are assessed using an adapted Gibb's model, 3 looking at: Description, Feelings, Evaluation, Analysis, Conclusions and Action Plan4.

Some examples of reflections: '...by actively listening...she really opened up’, ‘...my approach was different...in particular how they were coping as a couple’, ‘...knowledge to support, safety-net and signpost’, ‘...more confident in liaising with other members of MDT’, ‘I will continue to use knowledge from the course to facilitate more meaningful consultations.’

Conclusions

Reflection is a useful tool, which encourages and consolidates learning across specialities. Assessing the benefits of multi-professional learning is difficult, but the positive feedback highlights the use of assessment in this area. We continue to draw on the experiential learning opportunities, to improve outcomes for parents and professionals during this important period.

*Corresponding author Claire Jordan, The Whittington Hospital, clairejordan@nhs.net

The learners role in determining the fidelity of a simulation

*Mordi N, Burford B, Thomson R, Vance G

Background

Fidelity in clinical simulation is defined as the degree of similarity between the simulation and the workplace. It has been conceptualised in a multidimensional framework comprising of dimensions that can be manipulated depending on the learning objectives. One argument for high simulation fidelity is that it improves the learner’s engagement, allowing them to more readily ‘suspend disbelief’ and act as if they were in real life. The assumption is that the higher the fidelity the closer the match in behaviour in simulation to the workplace. It could follow therefore that there is an association between participants’ behaviour deviating from ‘real life’ and lower fidelity. As part of a study examining learners understanding and experiences of fidelity in clinical simulations this paper presents early results exemplifying influences on learners’ behaviour in simulations.

Methods

Three final year medical students took part in in-depth semi-structured interviews into their experiences of simulation and simulation fidelity. The interviews were transcribed and are undergoing coding to develop overarching themes. Ethical approval was obtained through the University Ethics committee.

Results

Initial data coding revealed moments where each student recalled acting differently in the simulation than they would have done in ‘real life’. In exploring their reasons for one theme emerged from the data relating to their preconceptions around the purpose of the simulation activity - what was being assessed and what the learning objectives were.

Discussion

Demonstrating differences in behaviour may give us deeper insight to the determinants of fidelity in clinical simulations. Based on these results, the learner plays a role in determining fidelity of a simulation. This is important as it may cause us to focus less on manipulating the environment, but rather on how we frame the simulations for learners so they are more inclined to act as they would in real life.

*Corresponding author Dr Nony Mordi, Newcastle University/Northumbria Healthcare Foundation Trust, n.mordi2@ncl.ac.uk

Safe and Effective Clinical Outcomes clinics in primary and secondary care: students’ perceptions of their educational value

*Bartlett M, Gay S, Kinston R, McKinley R.

Background

Untimed simulated surgeries in a general practice setting focussing on safe and effective clinical outcomes were first developed and introduced into undergraduate medical education in Otago, New Zealand (1). With agreement, we extended the concept and included a secondary care version for final year students. The clinics give opportunities to manage entire consultations and to make and implement clinical decisions with simulated patients (SPs). Faculty support is available in the form of ‘simulated colleagues’. Formative feedback is given by the SPs on the achievement of pre-determined outcomes from a patient’s perspective, and from faculty on clinical decision making, medical record keeping and case presentation skills.

Aim

To explore students’ perceptions of the educational value of SECO sessions in both settings.

Method

Ethical approval was obtained. Students were invited to take part in semi-structured group interviews immediately after their sessions and to give written feedback. Analysis was thematic, the themes arising from the data.

Results

We have data relating to 64 students in primary care and 194 in secondary care from pilot studies. These suggest that students enjoyed the clinics and wanted more of them in both settings. They identified gaps in their knowledge and recognised the unprecedented opportunity to develop the skills needed to make clinical decisions, to take responsibility for them and to handle uncertainty as a result of having to manage the whole consultation without being able to ‘play the student card’. The fictional contract was powerful. Students found feedback from faculty and SPs useful and most had plans to implement or develop their learning. For the majority, there were positive impacts on perceptions of self-efficacy. Negative comments related mainly to logistical issues.

Discussion

These clinics provide opportunities for learning and practicing, in an authentic setting, skills which students need to be prepared for their foundation years.

*Corresponding author Dr Maggie Bartlett, Keele School of Medicine, m.h.bartlett@keele.ac.uk

Crossing boundaries: can the OSCE method work in the context of healthcare science education in the same way as medical education?

*Gay S. Chamberlain S

The Modernising Scientific Careers (MSC) initiative was implemented in the UK in 2009 to provide a common framework for the education and assessment of the healthcare science workforce from Level 2 (school-leaver or young apprentice) to Level 8 (Consultant Clinical Scientist). Much of the structure of MSC mirrored that of the Modernising Medical Careers initiative that was implemented in 2005. This included the mirroring of assessment methods for workplace-based assessment (e.g. Observed Clinical Events and Direct Observation of Practical Skills) and the OSCE which is used as an exit assessment for the Scientist Training Programme (Level 7, Clinical Scientist).

The OSCE method is used across multiple healthcare sciences (27 sciences in 2016), with trainees required to completed three common ‘shared skills’ stations, and nine stations that are unique to their science specialism. Bearing in mind that the quality of assessment outcomes is determined by the quality of assessment inputs, and also mindful that medical education OSCEs differ in their design, this paper lists and compares some common features of OSCE design and delivery across the two contexts. These features include the types of station tasks, the number of stations, station timings, the use of actors and equipment, standard setting and common indicators of performance. This comparison shows that the healthcare science context is not quite comparable to medical education and that this presents some unique challenges when using the OSCE method.

*Corresponding author Mrs Sandie Gay, National School of Healthcare Science, sandie.gay@wm.hee.nhs.uk

Two birds, one stone - Using Podcasts as Assessment & Learning Tools in Dental Education

Corresponding author * Dr Hoda Wassif, University of Bedfordshire

As the use of technology increases in teaching and learning, there is more need to use technology in assessments to make it not only relevant but also engaging for postgraduate (PG) dental students. The aim of this presentation is to discuss the use of podcasts as an assessment and learning tool for PG students studying MA Dental Law and Ethics at the University of Bedfordshire, the only university accredited course designed for dental professionals.

Background

As a blended learning course that combines face to face teaching with online learning, the assessment strategy allows students to use technology where they are asked to submit a 10-minute podcast as part of 'Ethical Dental Practice' module. Students have the flexibility to select an ethical principle and offer a critique of that principle from an ethical and philosophical viewpoint with a reference to its application to their dental practice.

Using Podcasts

The podcast offers students an opportunity to present their views in a different format to the standard essay approach. Clinicians are often asked to be interviewed in the local media to present their views reflecting on dental practice in one way or another. Submitting a podcast allows students to practice and rehearse new skills and it could be simply recorded on their smart phones. On completion of the task, each podcast becomes an educational resource. Overtime, a digital resource is available to use as an online audio library.

Conclusion

The use of new technology in assessments is not a goal in itself. However by using podcasts, the technology enabled the assessment of learning and supported students to develop new skills that are relevant to practice. It also assisted the development of an on-going, renewed database of digital audio resource that can be used in teaching and online learning.

Why I think caveman tribes set the standards for formative assessment neurophysiology of tribalism.

*Doctor Michal Nowakowski MD, PhD, Department of Medical Education, Jagiellonian University Medical College, m.nowakowski@uj.edu.pl

It has been concluded that formative assessment does have positive impact on students’ performance. There are also numerous reports of stress as one of reasons for poor performance during testing and in real life circumstances. There are also multiple reports that encourage building positive study, assessment and work environments.

This presentation will discuss the impact human species evolution as tribal/social animals had on neurophysiology of human brain and how that explains why building positive environment for learning and formative assessment has strong positive impact on students’ learning.

Emotions associated with performed tasks and perception of environment are crucial for transfer of sensed phenomena to medium and long term memory. Defensive strategies often employed in unsecure environment do not promote contextualized long term memory formation but rather evolvement of avoidance strategies.

Dopamine driven push towards short term goals if properly utilized can significantly increase internal motivation of students.

Serotonin mediated social behaviours often linked to social status, tribalism, belonging but also team achievements and self-confidence are also very potent motivators which lack dopamine mediated addiction-like undesired results.
Oxytocin often associated with building of social and family structures, trust and empathy may play a crucial role in development of professional or corporate identity. Secreted also while observing empathic or trust based behaviours may explain crucial role of role modelling and development of cooperation and team based social skills.

Above mentioned neurohormones play crucial role in development of self-driven, patient oriented, empathic physician. For them to play their role student needs to be ‘inside’ a safe zone, included in a positive way in tribal mechanisms. Each tribe does have methods for positive enhancement of socially acceptable behaviours. Our type of that behaviour should include formative assessment.

Proper understanding of neurophysiology helps to understand many observed or even measured effects.